Diabetes Medications
The nurse administered 12 units of regular insulin to the patient with type 1 diabetes at 0700. Which meal prevents the client from experiencing hypoglycemia?
1. Breakfast.
2. Lunch.
3. Supper.
4. HS snack.
1.
Regular insulin peaks in 2 to 4 hours;
therefore, the breakfast meal would
prevent the client from developing
hypoglycemia
An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the functioning of the pump, the nurse bases the response on which information about the pump?
1. it is timed to release programmed doses of either short duration or NPH insulin into the blood stream at different intervals
2. it continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose
3. it is surgically attached to the pancreas and infuses regular insulin into the pancreas. This releases insulin into the bloodstream
4. it administers a small continuous dose of short-duration insulin subcutaneously. The client can self-administer an additional bolus dose from the pump before each meal.
4. an insulin pump provides a small continue dose of short duration (rapid or short acting) insulin subcutaneously throughout the day and night. The client can self administer an additional bolus dose from the pump before each meal as needed. Short duration insulin is used in an insulin pump. An external pump is not attached surgically to the pancreas.
1. increase in pH
2. comatose state
3. deep, rapid breathing
4. decreased urine output
5. elevated blood glucose level
2,3,5
Because of the profound deficiency of insulin associated with DKAm glucose cannot be used for energy and the body breaks down fat as a secondary source of energy. Ketones which are acid byproducts of fat metabolism, build up, and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis and the client becomes severely dehydrated. In untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul's respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia
The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which items when performing this care?
1. surgical mask and gloves
2. particulate respirator gown and gloves
3. particulate respirator and protective eyewear
4. surgical mask, gown, and protective equipment
2
The nurse who is in contact with a client with tuberculosis should wear an individually fitted particulate respirator. The nurse also would wear gloves as per standard precautions. The nurse wears a gown when the possibility exists that the clothing could be contaminated, such as when giving a bed bath.
The nurse is preparing to administer medications on a pulmonary unit. Which medication should the nurse administer first?
1. Prednisone for a client diagnosed with chronic bronchitis.
2. Oxygen via nasal cannula at 2 L/min for a client diagnosed with pneumonia.
3. Lactic acidophilus to a client receiving IVPB antibiotics.
4. Cephalexin to a client being discharged.
Oxygen is considered a medication and should be a priority whenever it is ordered. A client diagnosed with pneumonia will have some amount of respiratory compromise, and the ordered 2 L/min indicates a client with a chronic lung disease. This is the priority medication.
Which statement best describes the scientific rationale for prescribing metformin?
1. This medication decreases insulin resistance, improving blood glucose control.
2. This medication allows the carbohydrates to pass slowly through the large intestine.
3. This medication will decrease the hepatic production of glucose from stored
glycogen.
4. This medication stimulates the beta cells to release more insulin into the
bloodstream
3.
Metformin (Glucophage) is a biguanide that works to prevent gluconeogenesis in the liver. The scientific rationale for administering metformin (Glucophage) is that it diminishes the increase in serum glucose following a meal and blunts the degree of postprandial hyperglycemia by preventing gluconeogenesis.
The nurse provides instructions to a client newly diagnosed with T1DM. The nurse recognizes accurate understanding of measures to prevent diabetic ketoacidosis when the client makes which statement?
1. I will stop takin my insulin if Im too sick to eat.
2. I will decrease my insulin during times of illness.
3. I will adjust my insulin dose according to the level of glucose in my urine.
4. I will notify my primary health care provider if my blood cause level is higher than 250 mg/dl.
4. During illness, the client with T1DM is at increased risk of diabetic ketoacidosis, due to hyperglycemia associated with the stress response and due to a typically decreased caloric intake. As pat of sick day management, the client with diabetes should monitor blood glucose levels and should notify the PCP if the level is higher than 250 mg/dl. Insulin should never be stopped. In fact, insulin should be increased during times of illness. Doses should not be adjusted without the PCPs advice and are usually adjusted to blood glucose legalese, not urinary glucose readings.
The nurse teaches a client with diabetes mellitus about differentuating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? SATA
1. polyuria
2. shakiness
3. palpitations
4. blurred vision
5. lightheadedness
6. fruity breath odor
2,3,5
Shakiness, palpitations, and lightheadedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.
A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is commonly reported?
1. hot, flushed feeling
2. sudden chills and fever
3. chest pain that occurs suddenly
4. dyspnea when deep breaths are taken
3
the most common initial symptom in pulmonary embolism in chest pain that is sudden in onset. The next most commonly reported symptom is dyspnea, which is accompanied by an increased respiratory rate. Other typical symptoms of pulmonary embolism include apprehension and restlessness, tachycardia, cough, and cyanosis.
The client diagnosed with COPD is prescribed methylprednisolone IVP. Which laboratory test should the nurse monitor?
1. The white blood cell (WBC) count.
2. The hemoglobin (Hgb) and hematocrit (Hct).
3. The blood glucose level.
4. The blood urea nitrogen (BUN) and creatinine levels.
3.
Methylprednisolone (Solu Medrol) is a glucocorticoid. Steroid therapy interferes with glucose metabolism and increases insulin resistance. The blood glucose levels should be monitored to determine if an intervention is needed.
The client diagnosed with arterial hypertension develops a cold. Which information regarding over-the-counter (OTC) medications should the nurse teach?
1. Try to fi nd a medication that will not cause drowsiness.
2. OTC medications are not as effective as a prescription.
3. OTC medications are more expensive than prescriptions.
4. Do not take OTC medication unless approved by the HCP.
4. Dextromethorphan is sold under several names OTC. The most common is Robitussin. Dextromethorphan is an antitussive. Many OTC medications work by causing vasoconstriction, which will increase the client’s hypertension. The client should only take medications (approved by the HCP) that will not affect the client’s hypertension.
A client with type 1 diabetes mellitus who takes NPH daily in the morning calls to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise?
1. I should not exercise since I am taking insulin.
2. The best time for me to exercise is after breakfast.
3. The best time for me to exercise is mid-to late afternoon
4. NPH is a basal insulin, so I should exercise in the evening.
2.
Exercise is an important part of diabetes management. It promotes weight loss, decreases insulin resistance, and helps control blood glucose levels. A hypoglycemia reaction may occur in response to increased exercise, so clients should exercise either an hour after mealtime or after consuming a 10-15g carbohydrate snack, and they should check their blood glucose level before exercising.
A nurse is caring for a client hosptilized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? SATA
1. a low arterial PCO2 level
2. a hyper inflated chest noted on the chest X-ray
3. decreased oxygen saturation with mild disease
4. a widened diaphragm noted on the chest X-ray
5. pulmonary function tests that demonstrate increased vital capacity
2,3
clinical manifestations of chronic obstructive pulmonary disease include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. chest xray reveal a hyper inflated chest and a flattened diaphragm if the disease is advanced. Pulmonary function tests will demonstrate decreased vital capacity.
The nurse performs an admission assessment on a client with a diagnosis of tubercolosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis?
1. chest x-ray
2. bronchospy
3. sputum culture
4. tuberculin skin test
3.
tuberculosis is definitively diagnosed though culture and isolation of Mycobacterium tuberculosis. a presumptive diagnosis is made based on tuberculin skin test, a sputum smear that is positive for acid fast bacteria, a chest xray, and histolgocial evidence of granulomatous disease on biopsy.
Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this?
1. respiratory acidosis
2. respiratory alkalosis
3. metabolic alkalosis
4. metabolic acidosis
1
respiratory acidosis
The client with an acute exacerbation of reactive airway disease is prescribed a nebulizer treatment. Which statement best describes how a nebulizer works?
1. Nebulizers are small, handheld pressurized devices that deliver a measured dose of an anti-asthma drug with activation.
2. A nebulizer is an inhaler that delivers an antiasthma drug in the form of a dry, micronized power directly to the lungs.
3. A nebulizer is a small machine used to convert an anti-asthma drug solution into a mist that is delivered though a mouthpiece.
4. Nebulizers are small devices that are used to crush glucocorticoids so that the client can place them under the tongue for better absorption.
3.
This is the description of how a nebulizer works. Nebulizers take several minutes to deliver the same amount of drug contained in one puff from an inhaler. They are usually used at home, but can be used in the hospital.
The nurse is discussing oral glyburide with the client diagnosed with type 2 diabetes.Which information should the nurse discuss with the client?
1. Instruct the client to take the oral hypoglycemic medication with food.
2. Explain that hypoglycemia will not occur with oral medications.
3. Tell the client to notify the HCP if a headache, nervousness, or sweating occurs.
4. Recommend that the client check the ketones in the urine every morning.
1.
Glyburide (Micronase) is a sulfonylurea that stimulates the pancreatitis to secrete more insulin. The oral hypoglycemic medication should be administered with food to decrease gastric upset.
The community health nurse is conducting an education session with community members regarding the signs and symptoms associated with tubercolosis. The nurse informs the participants that tuberculosis is considered as a diagnosis if which signs and symptoms are present? SATA
1. dyspnea
2. headache
3. night sweats
4. a bloody productive cough
5. a cough with the expectoration of mucoid sputum
1,3,4,5
tubercolosis should be considered for any clients with a persistent cough, weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills. The clients previous exposure to tuberculosis should also be assessed and correlated with the clinical manifestations.
Which assessment data best indicates the client with type 1 diabetes is adhering to the medical treatment regimen?
1. The client’s fasting blood glucose is 100 mg/dL.
2. The client’s urine specimen has no ketones.
3. The client’s glycosylated hemoglobin is 5.8%.
4. The client’s glucometer reading is 120 mg/dL.
3.
A glycosylated hemoglobin (A1C) gives the average of the blood glucose level over the past 3 months and indicates adherence to the medical treatment regimen. A level of 5.8% is close to normal and indicates that the client is adhering to the treatment regimen. T
Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?
1. respiratory alkalosis
2. respiratory acidosis
3. metabolic alkalosis
4. metabolic acidosis
3
metabolic alkalosis
Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma?
1. This classification of asthma requires a combination of long-term control medication plus a quick-relief medication.
2. Mild intermittent asthma needs a routine glucocorticoid inhaler and a sustained relief theophylline.
3. This classification requires daily inhalation of an oral glucocorticoid and daily nebulizer treatments.
4. Mild intermittent asthma is treated on a PRN basis and no long-term control medication is needed.
4.
Mild intermittent asthma is treated on a PRN basis; long-term control medication is not needed. The occasional acute attack is managed by inhaling a short-acting beta2 agonist. If the client needs the beta2 agonist more than twice a week, moving to Step 2 (mild persistent asthma) may be indicated.
The school nurse is teaching a class about type 2 diabetes in children to elementary school teachers. Which information is most important for the nurse to discuss with the teachers?
1. The importance of not allowing students to eat candy in the classroom.
2. The increase in the number of students developing type 2 diabetes.
3. The signs and symptoms of hypoglycemia and the immediate treatment.
4. The need to have the students run or walk for 20 minutes during the recess period.
3.
The most important information for the teachers to know is how to treat potentially life-threatening complications secondary to the medications used to treat type 2 diabetes. The school nurse should discuss issues that keep the students safe.
The nurse is teaching a client with newly diagnosed type 1 diabetes about insulin therapy. Which statements indicate the client needs more teaching concerning insulin therapy? Select all that apply.
1. “If I have a headache or start getting nervous, I will drink some orange juice.”
2. “If I pass out at home, a family member should give me a glucagon injection.”
3. “Because I am taking my insulin daily I do not have to adhere to a diabetic diet.”
4. “I will check my blood glucose with my glucometer at least once a day.”
5. “I should administer my insulin in my abdomen for best absorption.”
3.
Even with insulin therapy the client should adhere to the American Diabetic Association diet, which recommends “carbohydrate counting.” This statement indicates the client needs more teaching.
The client with type 2 diabetes is admitted into the medical department with a wound on the left leg that will not heal. The HCP prescribes sliding-scale insulin. The client tells the nurse, “I don’t want to have to take shots. I take pills at home.” Which statement is the nurse’s best response?
1. “If you can’t keep your glucose under control with pills, you must take insulin.”
2. “You should discuss the insulin order with your HCP because you don’t want to take it.”
3. “You are worried about having to take insulin. I will sit down and we can talk.”
4. “During illness you may need to take insulin to keep your blood glucose level down.”
4.
Blood glucose levels elevate during times of stress, surgery, or serious infection. The client with type 2 diabetes may need to be given insulin temporarily to help keep the blood glucose level within normal limits. Although 3 is a therapeutic response and the client needs to have factual information.Therapeutic responses are used to encourage the client to ventilate feelings.
Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg, and HCO3 24 mEq/L. What does this mean?
1. respiratory alkalosis
2. respiratory acidosis
3. metabolic alkalosis
4. metabolic acidosis
2.
respiratory acidosis